Impact of mesorectal extranodal tumor deposits in magnetic resonance imaging on outcome of rectal cancer patients

Suvi T Marjasuo; Tiina E Lehtimäki; Laura E Koskenvuo; Anna H Lepistö

doi:10.1016/j.ejso.2024.108337

Impact of mesorectal extranodal tumor deposits in magnetic resonance imaging on outcome of rectal cancer patients

Eur J Surg Oncol. 2024 Apr 16;50(6):108337. doi: 10.1016/j.ejso.2024.108337. Online ahead of print.

Authors

Suvi T Marjasuo¹, Tiina E Lehtimäki², Laura E Koskenvuo³, Anna H Lepistö⁴

Affiliations

¹ Imaging Services, Tays Central Hospital, Tampere, Finland; University of Helsinki, Helsinki, Finland. Electronic address: suvi.marjasuo@helsinki.fi.
² University of Helsinki, Helsinki, Finland.
³ Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
⁴ Department of Surgery, Helsinki University Hospital and University of Helsinki, Finland; Applied Tumor Genomics, Research Programs Unit Organization, University of Helsinki, Helsinki, Finland.

PMID: 38657373
DOI: 10.1016/j.ejso.2024.108337

Abstract

Aim: Mesorectal extranodal tumor deposits (TDs) are identified in many rectal cancers. Their radiological features differ from metastatic lymph nodes, and they can be detected with magnetic resonance imaging (MRI). The purpose of this study was to determine the prevalence of rectal cancer TDs detected with MRI and their impact on overall (OS), cancer-specific (CSS), and disease-free survival (DFS) and the local recurrence rate.

Method: In this retrospective cohort study, we screened all 525 consecutive rectal cancer patients who underwent surgery during 2017-2018 in a tertiary center. Patients with synchronous metastases or who had not undergone MRI were excluded. We analyzed the OS, CSS, and DFS as well as local recurrences.

Results: Of the 480 included patients, TDs were detected in the images of 81 (16.9 %). Extramural venous invasion (EMVI) and TDs were frequently found together (n = 50, 61.7 % of all cases with TDs). The presence of TDs alone [hazard ratio (HR) 1.66 (1.03-2.68)] or TDs and/or EMVI [HR 1.63 (1.01-2.62)] were risk factors for adverse DFS in multivariate Cox regression analysis. The OS and CSS rates were poorer among patients with TDs compared to those without, p = 0.009 and p < 0.001, respectively. TDs were also a risk factor for local recurrence in the univariate analysis.

Conclusions: TDs detected with imaging are a risk factor for impaired DFS and associated with impaired CSS and OS of rectal cancer patients and should be taken into consideration in clinical decision-making.

Keywords: Magnetic resonance imaging; Rectal cancer; Tumor deposits.